Abstract
Debate over the merits and demerits of DSM-5 has been the talk of the town since release of the manual in May of last year. Despite all the anticipation, no Copernican revolution has occurred. DSM still follows the medical model of disease, defining nosological categories on the basis of clusters of symptoms. These categories are thought to represent disorders with a specific longitudinal course, prognosis, and (to a degree) response to treatment. Many of us, however, may be less familiar with an effort, equally important, that is slowly but steadily informing the way research in neuroscience and psychiatry is being conceptualized and carried out.
In 2010 NIMH released a blueprint, titled Research Domain Criteria (RDoC), intended to serve as a framework for neuroscience research. RDoC takes an approach different from that of DSM. It assumes (1) that mental disorders can be explained in terms of brain circuits and (2) that abnormalities of these circuits are identifiable and will lead to the discovery of “biosignatures”, ultimately to be integrated with clinical data. This effort should lead to a classification system based, as is generally the norm in medicine generally, on etiology and/or pathophysiology. Unlike DSM, RDoC is not yet a diagnostic system; rather, it is an attempt to create one.
In a major change, RDoC shifts the pivot of research away from symptoms and to the level of brain circuitry in an effort to identify circuit-based functional constructs. These functional constructs are grouped under broader domains of brain function.
But what exactly are these constructs and domains? Let’s take the example of cognition. Cognition constitutes a domain, like other brain functions identified by RDoC (e.g., negative affect, social processes positive affect, and regulatory systems). The domain labeled “cognition” subsumes a variety of constructs that can be the object of investigation: attention, long-term memory, cognitive control, working memory, executive function, and perception. These RDoC constructs are organized as a matrix. The columns represent the different units of investigation (genes, molecules, cells, circuits, and behaviors, as well as subjective reports), while the rows are the constructs themselves (for more information visit the RDoC site: http://www.nimh.nih.gov/research-priorities/rdoc/index.shtml.). Of course, there are several challenges to developing this approach, chief among them the need to establish interrater reliability in the way such domains are assessed.
Why is this at all relevant to psychoanalysis? First, psychoanalysts have been conceptualizing and treating, to some extent, constructs not very different from those that RDoC identifies. Just think of ego functions or developmental lines. Second, RDoC could be a productive framework for developing desperately needed research initiatives in psychoanalysis, which is uniquely suited to populate, in the RDoC matrix, the level of analysis involving subjective reports and behaviors. Third, because RDoC is being increasingly adopted by neuroscientists, using the framework proposed by NIMH could be an effective way to translate the insights of psychoanalysis into a language understandable to those who may have little acquaintance with our field.